Copper Toxicity Management

Symptoms and Diagnosis

• Copper toxicity can cause severe multi-organ damage including hematemesis, hypotension, melena, coma, headaches, behavioral changes, fever, diarrhea, abdominal cramps, Kayser-Fleischer rings in the eyes, and jaundice, requiring prompt treatment with chelating agents such as D-penicillamine 1, 2
• Hematemesis (vomiting blood) is a symptom of copper toxicity 1
• Melena (black "tarry" feces) is a symptom of copper toxicity 1
• Diarrhea and abdominal cramps are symptoms of copper toxicity 1
• Headaches and behavioral changes are symptoms of copper toxicity 1
• Coma can occur in severe cases of copper toxicity 1
• Neurological deterioration can occur in copper toxicity 3
• Hypotension is a symptom of copper toxicity 1
• Jaundice is a symptom of copper toxicity 1
• Liver failure (often the first organ affected) can occur in copper toxicity 1
• Hemolytic anemia can occur in copper toxicity 3
• Coagulopathy unresponsive to vitamin K can occur in copper toxicity 3
• Kayser-Fleischer rings (brown ring-shaped markings in eyes) are a pathognomonic finding in copper toxicity 1, 3
• Fever is a symptom of copper toxicity 1
• Measurement of serum copper and ceruloplasmin levels is used in the diagnosis of copper toxicity 3
• CRP determination is used to differentiate copper toxicity from inflammatory conditions 1
• Liver function tests are used in the diagnosis of copper toxicity 3
• Slit-lamp examination for Kayser-Fleischer rings is used in the diagnosis of copper toxicity 3
• 24-hour urinary copper measurement is used in the diagnosis of copper toxicity 3

Treatment Approach

• D-penicillamine (250-500 mg/day initially, then increased by 250 mg increments every 4-7 days to a maximum of 1000-1500 mg daily in divided doses) is used in the treatment of copper toxicity 1
• Zinc administration (competes with copper for absorption) is used in the treatment of chronic copper toxicity 1, 3
• Lifelong therapy with copper chelating agents is used in the treatment of Wilson's disease 3
• Regular monitoring of copper levels is essential in the treatment of copper toxicity 3
• Liver transplantation may be considered in severe cases of Wilson's disease 3
• First-degree relatives of patients with Wilson's disease should be screened 3
• Regular monitoring of liver and renal function is essential in the follow-up of copper toxicity 3
• Periodic measurement of serum copper levels is essential in the follow-up of copper toxicity 3
• In patients on parenteral nutrition, copper levels should be checked every 6-12 months 1